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High fitness levels, frequent sauna bathing and risk of pneumonia in a cohort study: Are there potential implications for COVID‐19?

Kunutsor et al., European Journal of Clinical Investigation, doi:10.1111/eci.13490
Jan 2021  
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Case 25% Improvement Relative Risk Exercise  Kunutsor et al.  Prophylaxis Does physical activity reduce risk for pneumonia? Prospective study of 2,275 patients in Finland Fewer cases with higher activity levels (p=0.0049) c19early.org Kunutsor et al., European J. Clinical .., Jan 2021 Favorsexercise Favorsinactivity 0 0.5 1 1.5 2+
Exercise for COVID-19
9th treatment shown to reduce risk in October 2020
 
*, now with p < 0.00000000001 from 67 studies.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,800+ studies for 102 treatments. c19early.org
Prospective study of 2,275 middle-aged Finnish men showing significantly lower risk of future pneumonia with a combination of high cardiorespiratory fitness and frequent sauna bathing compared to each exposure alone. High cardiorespiratory fitness and frequent sauna bathing (2-7 sessions per week) were each independently associated with lower pneumonia risk after adjusting for potential confounders.
Study covers thermotherapy and exercise.
risk of case, 25.0% lower, RR 0.75, p = 0.005, high activity levels 227 of 1,137 (20.0%), low activity levels 302 of 1,138 (26.5%), NNT 15, adjusted per study, multivariable, model 3.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Kunutsor et al., 22 Jan 2021, prospective, Finland, peer-reviewed, 2 authors. Contact: skk31@cantab.net.
This PaperExerciseAll
High fitness levels, frequent sauna bathing and risk of pneumonia in a cohort study: Are there potential implications for COVID‐19?
Setor K Kunutsor, Jari A Laukkanen
European Journal of Clinical Investigation, doi:10.1111/eci.13490
Pneumonia infection is the result of a complex inflammatory process where the lower respiratory tract suffers the invasion of an infective microorganism (viruses or bacteria). Major risk factors that predispose to pneumonia include smoking, obesity, underweight, excessive alcohol consumption and comorbid conditions such as asthma,
CONFLICT OF INTEREST No potential conflict of interest was reported by the authors. AUTHOR CONTRIBUTIONS SKK contributed to study design, data analysis and interpretation, drafting manuscript, and revising manuscript content and approving the final version of the manuscript; JAL contributed to study design and conduct, responsibility for the patients and data collection, and revising manuscript content and approving the final version of the manuscript. SUPPORTING INFORMATION Additional supporting information may be found online in the Supporting Information section. How to cite this article: Kunutsor SK, Laukkanen JA. High fitness levels, frequent sauna bathing and risk of pneumonia in a cohort study: Are there potential implications for COVID-19?. Eur J Clin Invest. 2021;51:e13490. https://doi.org/10.1111/eci.13490
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To explore these putative roles, we evaluated the independent and joint ' 'associations of cardiorespiratory fitness (CRF) and frequency of sauna bathing (FSB) with ' 'pneumonia risk in a prospective cohort study of 2275 men aged 42‐61\xa0years at ' 'recruitment.</jats:p></jats:sec><jats:sec><jats:title>Material and ' 'Methods</jats:title><jats:p>Objectively measured CRF and self‐reported sauna bathing habits ' 'were assessed at baseline. CRF was categorized as low and high (median cut‐offs) and FSB as ' 'low and high (defined as ≤1 and 2‐7\xa0sessions/wk, respectively). Multivariable‐adjusted ' 'hazard ratios (HRs) with confidence intervals (CIs) were calculated for incident ' 'pneumonia.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>During a ' 'median follow‐up of 26.6\xa0years, 529 cases of pneumonia occurred. Comparing high vs low ' 'CRF, the multivariable‐adjusted HR (95% CIs) for pneumonia was 0.75 (0.61‐0.91). Comparing ' 'high vs low FSB, the corresponding HR was 0.81 (0.68‐0.97). Compared to men with low CRF ' '&amp; low FSB, the multivariable‐adjusted HRs of pneumonia for the following groups: high CRF ' '&amp; low FSB; low CRF &amp; high FSB; and high CRF &amp; high FSB were 0.88 (0.65‐1.20), ' '0.89 (0.71‐1.13), and 0.62 (0.48‐0.80) ' 'respectively.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In a ' 'general male Caucasian population, a combination of high fitness levels and frequent sauna ' 'baths is associated with a substantially lowered future pneumonia risk compared with each ' 'modality alone. The implications of these findings in altering COVID‐19 disease or its ' 'severity deserve study.</jats:p></jats:sec>', 'DOI': '10.1111/eci.13490', 'type': 'journal-article', 'created': {'date-parts': [[2021, 1, 15]], 'date-time': '2021-01-15T04:22:50Z', 'timestamp': 1610684570000}, 'update-policy': 'http://dx.doi.org/10.1002/crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 11, 'title': 'High fitness levels, frequent sauna bathing and risk of pneumonia in a cohort study: Are there ' 'potential implications for COVID‐19?', 'prefix': '10.1111', 'volume': '51', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-2625-0273', 'authenticated-orcid': False, 'given': 'Setor K.', 'family': 'Kunutsor', 'sequence': 'first', 'affiliation': [ { 'name': 'National Institute for Health Research Bristol Biomedical ' 'Research Centre University Hospitals Bristol and Weston NHS ' 'Foundation Trust and the University of Bristol Bristol UK'}, { 'name': 'Musculoskeletal Research Unit, 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